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form. The malarial poison, whether chemical or germ, acts upon the liver in such a manner as to slow the elimination of effete matter. The elimination of effete matter is accomplished through the liver, skin, kidneys and lungs. In the state of health these organs assist each other, keeping a normal balance. If an individual goes from a warm to a cold climate, the elimination through the skin and lungs is decreased. If the liver and kidneys are healthy, no harm results. If, however, as in the case of the malarial person, the liver is sluggish, it will be unable to do the work devolving upon it, and the system is poisoned with the non-eliminated effete matter. This irritates the brain and produces the chill and increase in temperature. This theory exactly agrees with my clinical experience. Antipyretics have little effect upon the disease until the liver is cleared. Catharsis is not the essential factor, because compound cathartic pills and other like drugs may be given until the patient is exhausted, without any material benefit. On the other hand, if the case is seen early, calomel may be given in so small doses as to effectually clear the skin, without producing catharsis.

If a person residing in a malarious country, not being sick at the time, takes a thorough mercurial treatment before going to the North or to the sea shore, he will probably escape the usual sickness. While I would emphasize the importance of extra care as to clothing in making this change of climate, I regard the preparatory treat

TABLES FROM WHICH THE ACCOMPANYING DIAGRAMS WERE DRAWN.

No. 13.-Average Temperature, 14 Stations. Average Daily Range Temperature. Intermittent Fever, U. S. A.

Jan.

Feb. March. April. May.

June. July. Aug. Sept. Oct.

Nov. Dec.

Av.

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25.6 32.

38.5

36.S 28.1

19.3

26.5

No. 14.-Michigan Day and Night Ozone. Relative and Absolute Humidity.

Average Temp.

Per cent. Int. Fever.

Day Ozone.

3.33

3.46

3.44

3.21

3.09

2.88

2.69

2.88

2.74

Night Ozone.

2.78

3.01

3.18

3.06

3.91

4.04

4.07

3.56

3.31

2.98

2.55

Relative Humidity

2.49

2.54

2.99

3.35

3.55

3.23

.81

.80

-77

.69

.68

Absolute Humidity.

.72

.72

.74

-75

.76

.79

.82

.75

1.38

1.51

1.81

2.75

3.91

5.27

6.07

5.84

4.98

3.71

Average Temperature.

2.30

1.73

3.44

20.56

23.62

29.80

44.33

56.08

65.10

70.52

68.14

61.67

Per Cent. Fever..

50.83 36.08

26.60

58.4

46.11

60.8

62.75

70.4 75.8

77.8

79.5

79.0

79.0

76.1 67.0

58.8

70.4

No. 15.-Deaths New York State from Intermittent Fever.

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Av. Maximum and Minimum and Mean Temperature. Intermittent Fever Native Troops.

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Daily Range Temp. and Intermittent Fever Ft. Apache, Arizona.

Average Temperature.

Daily Range Temperature

Sickness

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69.69 78.89 88.60 92.42 89.58
35.94 38.94
14.77 14.89 11.62

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ment as the more important. In fact, a person whose liver is active will need less clothing for comfort than if his liver is sluggish. In some cases, it is necessary to continue small doses of the chloride or iodide for some time.

The usefulness of this treatment is generally known, and is admitted by Dr. Baker in conclusion seven. If, however, his theory is correct, any cathartic, decreasing the tension of the portal circulation, or heavy clothing would prevent the outbreak, as well or better.

How does a mercurial decrease the temperature? It certainly has an antipyretic influence upon a malarial fever or upon diphtheria, but it does not have any appreciable effect upon a healthy person. This effect is certainly not derived through increased heat elimination, and it must therefore be by reducing the production of heat. Since, however, it does not materially check the production of heat in a healthy person, this result must be the incidental result of the removal or neutralization of the irritating cause of the fever. If this is true the fever following a chill is not the result of non-eliminated heat being stored up, as Dr. Baker suggests. Further, if I am not mistaken, the experiments of Osler show that in intermittent fever there is increased heat production

With regard to conclusions three and four it might be asked, how does Dr. Baker's theory explain the cause of delay in reaction from cold. The healthy person would react promptly;

therefore this delay in reaction shows that neither the chill nor the fever represent the beginning of the disease. The mechanical effect of a chill may be a local congestion, but as soon as the cause is removed the system reacts and the only results are local primarily. If the intermittent fever is the result purely of the daily range of atmospheric temperature, since the body is daily exposed to the cold, the chill and fever would always be of the remittent type.

I am surprised to see conclusion six repeated. "In our climate those measures, such as drainage, which enable the soil to retain warmth during the night and thus reduce the daily range of temperature immediately over such soil, tend to decrease intermittent fever among residents there

Does drainage enable the soil to retain warmth? Almost any boy will tell you that sand in the sun is hot, but as soon as a shadow is thrown upon it it cools off. The rich black loam heats slowly and cools slowly. Dry climates are those most subject to great range of temperature. In northwestern Texas the traveler may suffer extremely from the heat by day, but at night he covers himself with a thick blanket and places a little water in a saucer from which he skims a thin layer of ice in the morning. In India we have already seen that there is the greatest range of daily temperature when the ground is dry. Dr. Chas. Denison took the rec

8 I ordinarily prescribe two cathartic doses of calomel combined with ipecac, the first to be taken a week before starting, and the second three days after.

ords of 25 dry and 25 moist climates and obtained therefrom the mean daily range of temperature for four classes of places as follows:

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On the contrary, then, drainage increases the daily range of temperature, and so if Dr. Baker's theory is correct it ought to favor the production of intermittent fever.

On page 417 of the Report of the Michigan State Board of Health for 1880, I found the following report from one of the correspondents of the board. " During the first half of the month (August) the moisture in the air was as abundant and the temperature so uniformly high, that unhusked corn in the shock, also corn in the corn cribs began to grow vigorously. During the third week of the month malarial diseases rapidly arose, which I think was partially due to the prolonged uniform heat and moisture. There was also one half less azone during the first half than during the last half of the month." This report is for Washington, in the southeast part of the State. From the same report, pages 317, 321, 326, 344, and 349, I get the mean temperature, absolute humidity, day and night ozone at Washington, and mean daily range of temperature at Detroit as follows (having no like data for Washington).

9 Transactions of Ninth International Vol. v, p. 40.

Medical Congress,

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